At the last meeting of the American Gynecological Society, Goodman of Kentucky read a paper on the use of ergot after labor, in which he claimed that it should be the invariable rule never to give ergot at the close of the third stage, unless the danger of hemorrhage was imminent, and then hypo dermatic injection of ergotine was the preferable method. lie stated that the purposes for which ergot was administered were three in number: To prevent after-pains; to promote involution; to prevent postpartum hemorrhage. It was his belief that the only real benefit to be derived from the use of ergot was the prevention of hemorrhage, but that its use was attended with such risks that he did not believe there was warrant for administering it indiscriminately. He regarded the belief that ergot hastened involution as absurd, and although the drug unquestionably averted or arrested after-pains, it did so by setting up an action of the muscles which was not physiological.
In the discussion of this paper, which in certain of its arguments must be considered over-drawn, Reamy, of Cincinnati, agreed practically with the author, stating that from his own observations he was satisfied that the natural state of the circulation in the uterine wall, after the placenta had been delivered, could not be reached if the normal intermittent con tractions of the uterine muscle were made persistent. " Ergot not only closes up the uterus, but likewise interferes with the circulation within it, and therefore interferes with the process of involution and must lay the foundation for sepsis. Ho was perfectly satisfied that more evil is be ing done to-day by this item in obstetric practice throughout the coun try, than by any other one thing." It is thus apparent that there is no lack of variety in the views held in this country in regard to ergot, and yet in one respect there is more or less uniformity, and this is in regard to the fact that the drug adminis tered before the uterus is emptied may be productive of harm. Such being the case, why, we would repeat, resort to it under any conditions where one or another more harmless agent is productive of the desired end ?—Ed.} Method of Administration of Ergot.
Ergot may be administered either in powder, or in infusion, [or in fluid extract.—Ed.] Thus given, however, it is sometimes not tolerated by the stomach, and therefore the attempt has been made to administer it su ben taneously.
Dick, of Berne, has recently studied the comparative action of ergot and ergotine, and states: " 1. Ergot acts more rapidly than ergotine. 2. The only difference in regard to ergot by the mouth and ergotine subcu taneously is that the effects of the latter are not so lasting. 3. Uterine tetanus has never been observed after ergotine."
We believe, on the contrary, that ergotine subcutaneously acts more quickly than ergot, and the duration of the action of ergotine is far longer than that of ergot.
The following formula for solutions of ergotine are given by Naegele and Grenser: • Ijb Extract of ergot, . 3 j Glycerine, dilute alcohol . ful 3 ij A Pravaz syringeful will contain 3{ grains of ergotine.
Iji Bonjean's ergotine, . 3 SU Glycerine, distilled water . . Ai 3 ss Bonjean's ergotine. 3 SS Glycerine, . j We believe that all the above solutions are likely to cause abscess, and we therefore use Yvon's solution, which has always answered us well. Ho prepares his solution so that fifteen minims shall contain exactly fif teen grains of ergot, and we are thus absolutely certain of the dosage. From the use of this solution we have never seen abscess. There occurs simply a trifling induration of the cellular tissue at the injection site. Similarly does Herrgott maintain the efficacy and advantages of Yvon's solution administered subcutaneously. In promptness of action it is far superior to any other method of administration; it is perfectly innocuous when the solution has been carefully made. There is never consecutive pain or inflammation. Herrgott has never administered more than fifteen grains. We have given in urgent cases double this dose. We would add that Yvon's solution may as well be administered by the mouth, in the dose of thirty to forty drops, and that when we have used it subcu taneously it has always been well borne, and has never excited either nau sea or vomiting.
[The tablet triturates of ergotine, or the hypodermic pellets, if reliable, are excellent forms for the administration of ergot. In case of an emer gency, however, a drachm of the officinal fluid extract may be given hypodermatically, provided the precaution is taken to insert the needle deep into the muscles, without fear of resulting abscess. During the puerperium, ergot had better be administered as the aqueous extract, grains five, in suppository, twice or thrice daily, and it may advantageously be combined with a quarter to an eighth of a grain of cannabis indica.
We would mention, finally, that of late years the fluid extract of cotton root (Gossypii radicis) has been used to some extent in place of ergot, for the reason that it is said to be just as effective an oxytocic, and yet not to possess the disadvantageous property of causing tetanic contrac tion of the uterine muscular fibre. We can answer for its marked oxy tocic property, bilt are not in a position to affirm that it is otherwise superior to ergot. We should be inclined to place absolutely the same limitations to its use, for the present, as we believe are applicable to ergot.—Ed.]